Femoroacetabular Impingement

[Timeoutofmind]

I see a decent amount of patients with positive hip exam and Xrays suggest FAI

My understanding was that if left untreated, could lead to accelerated deterioration of the joint...Therefore, do you send all these people to ortho right away?

Some orthos seem to want me to try a shot first...

Thanks in advance

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[SSdoc33]

I see a decent amount of patients with positive hip exam and Xrays suggest FAI

My understanding was that if left untreated, could lead to accelerated deterioration of the joint...Therefore, do you send all these people to ortho right away?

Some orthos seem to want me to try a shot first...

Thanks in advance

not all need a surgery. hip arthroscopy is a much bigger deal than knee arthroscopy. if there is a large or discrete labral tear along with the FAI, they are better candidates, and hip arthroscopy is really only for the relatively young -- teens to 30's or so.

shot + PT will probably help about half of them

 

[Baron Samedi]

Agree that surgery is rarely the answer.

Shot is typically beneficial and also helps rule out extra articular causes such as psoas pathology, greater trochaneteric pain, upper lumbar radiculopathy, or SIJ referred pain.

 

[cowboydoc]

I see a decent amount of patients with positive hip exam and Xrays suggest FAI

My understanding was that if left untreated, could lead to accelerated deterioration of the joint...Therefore, do you send all these people to ortho right away?

Some orthos seem to want me to try a shot first...

Thanks in advance

PT, PT, PT
Avoid symptomatic extremes of range
I'm doing an injection or getting arthrogram before sending anyone for surgical consult.
It's not so much age as presence of OA.
Very few surgeons should be doing a hip scope!

 

[bedrock]

I see a decent amount of patients with positive hip exam and Xrays suggest FAI

My understanding was that if left untreated, could lead to accelerated deterioration of the joint...Therefore, do you send all these people to ortho right away?

Some orthos seem to want me to try a shot first...

Thanks in advance

Steroid injection with lido can confirm diagnosis.

Would definitely do PT and try Regenerative Medicine before ever sending to ortho.
And you need to really research which ortho. Most ortho are terrible at hip scopes and can make patient worse.
Only a couple guys in each state are worth going to for hip arthroscopy.

If patient has time/money, the guru of hip arthroscopy is Marc phillipon at Steadman clinic in Vail.

 

[emd123]

I know more about this diagnosis than I normally would through my practice, because my wife has it. She had pincer and cam type. She had no idea she had it until she became very advanced at yoga (extreme hip range of motion). She did get better for a while with a hip injection, which ortho was totally okay with. An MRI arthrogram ended up showing a labral tear. The pain kept getting worse. Her local ortho, a very good hip guy, told her that he wouldn't trust anyone within 2 hours of his office including himself, to do a hip scope on her so we went to two different guys at Big City University type settings. The guy she chose did a great job but also does tons of them. All he does is hip scopes. He peeled the labrum back, shaved down the prominent acetabular rim (pincer type), repaired the labral tear, tacked it back down to the acetabulum, then shaved down the bony prominence she had on the femoral neck (cam type). She's 1.5 years out and has been pain free ever since, and is back to doing yoga putting her feet behind her head and doing splits and is soon to be teaching it, too.

Guys very good at this in South East:

Guillaume Dumont, Columbia, SC
Allston Stubbs, Wake Forest, NC

 

[SSdoc33]

I guy I know who does a ton of hip scopes. Wont see anyone over 40. Rarely does patients > 35